Giving the Gift of an Advance Medical Directive
 There's no doubt about it…thinking about death, especially your own, is no easy task. Talking about it with people you love, whether you're 30 years old or 80 years old, is even harder. Add to this asking someone to make decisions on your behalf if you become so ill you can't do it on your own, and it's easy to see why a majority of Americans do not have Advance Medical Directives or Medical Powers of Attorney in place.  
But it doesn't have to be that difficult, experts say, especially when people start thinking about these conversations as a gift – gifts you can give anytime during the year.  "It's hard to think about these things," said Dr. Laura Cunnington, Riverside Health System's Medical Director for Palliative Care and Hospice Services. "The flip side is that it is so much harder if you haven't thought about it and someone has to figure out what they should do for you. You give them a gift by taking that burden away."
Healthcare organizations are required to provide information about healthcare decision-making rights and to ask all patients if they have an Advance Directive. Making future healthcare decisions includes much more than deciding what care they would or would not want. Instead, the National Hospice and Palliative Care Organization recommends that we think about how we want to live. "That's what this is really about," says Cunnington. "When the end of life is near, our experience of living – being with our family, being free of pain and suffering – are the things that become important to most people."
If you ask any emergency department staff member, "you'll hear that they have a great respect for an Advance Directive," said Kim Harper, RN, the Director of Emergency Services at Riverside Walter Reed Hospital. "We see the things that happen that are unanticipated. The car accidents, the shootings...the 21 or 35-year-old who has a heart attack who had no idea they had heart trouble." In those situations, which are already incredibly hard for families, "having an Advance Directive can help decrease the anxiety a family faces." Or will continue to face years to come. Harper has seen it firsthand. 
While working at a trauma center, a pregnant woman came in for treatment after having had "a stroke and developed a blood clot. The baby was born and was fine. But she was declared brain dead and put on a ventilator. The family had to make the decision about what to do. They are the ones who have to carry that burden." In general, Harper said, "People think that accidents won't happen to them and they won't get sick. For the most part, they are probably right. But if accidents do happen or they do become ill, Advance Directives takes the burden off the shoulders of family and gives more control to patients."
"Only 25 percent of adults are estimated to have Advance Medical Directives completed and in place," said Carol Wilson, Riverside's Director of Palliative Care Services and Advance Care Planning. More so, only half of the adults who have an advanced illness have done the planning. "In general, young people think about it less," Wilson said. "We all like to think we're immortal and this planning requires us to think about what makes life worth living, if we would want to be kept alive at the end of a terminal illness or in the event of a brain injury, and under what conditions we would want treatment stopped."
Even Cunnington used to be part of that statistic. "When my husband and I were in our 30s, he was in a terrible motorcycle accident and he was unconscious for three days," she said. "He's fine now. But at that time we hadn't had the conversation. You think you know someone so well because they are your spouse, but when it comes to life and death decisions it's far better to have had that conversation."
"Advance Medical Directives not only should be done by everyone, but should also be updated and revisited as you age," Cunnington said. "What your Advanced Care Directive says in your 30s could be different if you are in your 60s and have a diagnosis of a serious illness." Cunnington said.
The reasons many people have not started this type of planning, Cunnington said, is "No time." "Not important." "Didn't want to talk about something so depressing." Cunnington gets that. "I'm a palliative medicine physician and I have these discussions all day, every day," she said. "When I have these discussions with my own parents, though, it's not easy."
So Cunnington talks about Advance Medical Directives as a gift. "Once you get to the hospital, there may be a multitude of reasons why you can't make your own decisions," Cunnington said. "Having a loved one in the hospital can be very distressing for families. It's already stressful enough to be in the hospital, but then to be asked to make decisions like this can be very hard. Having your wishes already in place at this difficult time is a gift to them, as they make difficult decisions about your care. For more information about advance care planning, visit 
 Every family is different. Some are accustomed to talking about death and dying. For those, the conversation may be easier to start.
 For others, consider the following tips to help start the conversation about establishing your Advance Medical Directive.
1. Blame it on the media. Piggy-back off of something you see on TV, read in the paper, or current events. If a medical show has a dangerous medical situation in a plot line, for example, use that as a way to say, "if I were ever in that situation…" to get the conversation started.
2. Blame it on your doctor. After a doctor's appointment, tell your family your physician has asked you to talk about it as a way of ensuring all your medical paperwork is up to date. Be sure to say it isn't because of a recent diagnosis.
3. Blame it on your lawyer. Tell your family you are completing your estate planning and your lawyer includes  a living will or Advance Medical Directive, and you want to ensure all your paperwork is up to date.
4. Blame it on Healthcare Decisions Day. Tell your family this is a gift you want to give them and now is the time to do it.
What questions will I be asked?
The first thing on the Advance Medical Directive is naming the person who will be your healthcare agent. This is the person you trust to speak for you, a person who would make decisions as you would.
Who should I name as my healthcare agent?
This part is harder, even though many think it's easily a spouse. The reality is you are asking someone to be responsible for making your medical decisions and someone that close to you may be emotional during a challenging medical time. Consider someone who could play that role and who will make decisions on your behalf.
Where can I get the documents?
Riverside Health System offers the necessary documents online at . Once you have completed the forms, you have to sign and date them with two witnesses. They do not need to be notarized.
Where do I store my Advance Medical Directive?
Make copies and give one to your healthcare agent, anyone who is close to you and your primary care physician. Anytime you received medical services, you will be asked for this document.

Published: April 14, 2014